Provider Demographics
NPI:1336329846
Name:MATTHEW LONG DO ET AL PTR
Entity Type:Organization
Organization Name:MATTHEW LONG DO ET AL PTR
Other - Org Name:RIGGS LONG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:RIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-325-6854
Mailing Address - Street 1:3445 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6658
Mailing Address - Country:US
Mailing Address - Phone:310-325-6854
Mailing Address - Fax:310-325-6014
Practice Address - Street 1:3445 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 320
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6658
Practice Address - Country:US
Practice Address - Phone:310-325-6854
Practice Address - Fax:310-325-6014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty